# Changes in Care and Outcome for Children and Adolescents Living With HIV/AIDS During the COVID19 Pandemic in Germany—A Longitudinal Study

## TL;DR

This study shows how the COVID-19 pandemic affected HIV care and outcomes in German children and adolescents.

## Contribution

The study provides longitudinal data on medical visits and HIV outcomes during the pandemic in a pediatric cohort.

## Key findings

- Medical visits decreased during the pandemic, especially in male patients.
- Viral load control became more fragile, with more borderline cases during the pandemic.
- Younger age was associated with fewer medical visits before and during the pandemic.

## Abstract

The COVID‐19 pandemic impacted daily life and healthcare. This study investigated how this affected the outcome in children and adolescents living with HIV/AIDS.

This study investigated medical visits and outcomes (viral load, immunological parameters) in participants in the German Pediatric and Adolescent HIV cohort for 30 months, covering a period before and during the COVID‐19 pandemic.

Fifty‐two participants receiving antiretroviral therapy (27 females, 25 males; median age: 18 years, IQR: 15.0, 22.0) were analysed. Fifty percent of patients had fewer medical visits, 21% had an unchanged number of visits, and 29% had more medical visits when comparing the pandemic period with the prior period. (p = 0.016). This decline is primarily attributed to the first phase of the pandemic, where the incidence ratio of medical controls was 0.66 (95% CI 0.42–0.97) compared to the previous period (p = 0.05).

In male patients, there was a significant reduction in medical visits which was not seen in females. Among male patients, 60% experienced a decrease in control visits, while 20% remained unchanged (p = 0.015). Age of the patients was significantly negatively associated with number of visits (rho = −0.39; 95% CI [−0.63 to −0.15]; p = 0.004) before and during the pandemic (rho = −0.37; 95% CI [−0.58 to −0.12]; p = 0.007).

Half of the participants did not present with positive viral loads (≥ 20 cps/mL) in any of the two periods. Borderline cases of viral load measurements increased during the pandemic from 38% to 62% cases (p = 0.03), with the largest difference during the first wave.

Overall, the study shows a negative impact during the COVID‐19 pandemic on the outcome in children and adolescents living with HIV in Germany and indicates the fragile nature of virological control in this population. Appropriate measures including virtual consultations should be implemented to improve outcome in future pandemic situations.